Pacemaker Laser Lead Extraction and Reimplantation of Dual-Chamber Implantable Cardioverter Defibrillator Via Mustard Baffle in Complete Transposition of Great Arteries

Abstract

We present a case of a complicated lead extraction and reimplantation of an implantable cardioverter defibrillator (ICD) in a young woman with complete transposition of great arteries (CTGA), a cyanotic congenital heart defect in which the aorta and the pulmonary trunk are transposed. The malformation results in two parallel circulations, whereby the left ventricle is attached to the pulmonary trunk and the right ventricle is attached to the aorta. Survival depends on the mixing of these two circulations at the level of the atria or ventricles or great arteries. Balloon atrial septostomy and creation of an intra-atrial baffle are procedures that increase atrial mixing, increase systemic oxygenation, and hence improve survival. With the improved survival of patients with CTGA, there is an increasing need for permanent pacemakers (PPMs) and ICDs for rhythm disturbances. These leads and/or devices are often inserted when the patients are very young and need to be replaced or explanted in adulthood due to device or lead malfunction, device-associated infection, or generator replacement or upgrades. These procedures are often complicated by the patients' complex anatomy and/or shunts. We describe a patient with CTGA who had an intra-atrial baffle and a nonfunctioning dual-chamber PPM. The lead was extracted via the baffle and the old PPM was upgraded to an ICD. Such descriptions are rare.